Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Methotrexate but Not TNF-Blockers Reduces Immune Response Following Pneumococcal Vaccination Using 7-Valent Conjugate Pneumococcal Vaccine (Prevenar) in Adult Patients with Established Arthritis.

Kapetanovic5,  Meliha C., Roseman5,  Carmen, Jonsson1,  Göran, Truedsson4,  Lennart, Saxne3,  Tore, Geborek2,  Pierre

Dept of Clinical Sciences Lund, Section of Infectious Diseases, Lund University, Lund, Sweden
Dept of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
Dept of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sweden
Dept of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden
Section of Rheumatology, Lund University, Lund, Sweden

Aim:

To study the influence of anti-inflammatory treatments including methotrexate (MTX) and TNF-blockers on serological response following pneumococcal vaccination using 7-valent conjugate vaccine (Prevenar®) in adult patients with established arthritis.

Patients and Methods:

Altogether 506 patients with rheumatoid arthritis (RA) or spondylarthropathy (SpA) including psoriatic arthritis were vaccinated. All patients were stratified into 6 prespecified groups based on diagnosis and type of anti-rheumatic treatment: 1. RA patients treated with methotrexate + in some cases other DMARDs (n=85; 79 % female; mean age 62 years); 2. RA patients on TNF blockers as monotherapy (n=80; 88% female; mean age 60 years); 3. RA patients on anti-TNF +MTX + possibly other DMARDs (n=89; 78% female; mean age 60 years); 4. SpA patients on anti-TNF drugs as monotherapy (n=83; 34% female; mean age 49 years); 5. SpA patients on anti-TNF drugs +MTX (n=83; 53% female; mean age 50 years) and 6. SpA patients on NSAIDs and/or analgesics (n=86; 45% female; mean age 52 years). Group 5 served as a control group. All patients received one dose of 0,5 ml Prevenar intramuscularly. Levels of IgG antibodies against two pneumococcal serotypes (23F and 6B) were measured prior to and 4–6 weeks following vaccination using standardised ELISA.

Results:

Postvaccination geometric mean IgG levels increased significantly for both serotypes in all groups compared to baseline (p=0.000). Immune response (IR); i.e ratio between post- and prevaccination antibody levels differed significantly between the groups. Patients with spondylarthropathy on NSAIDs and/or analgesics (controls) had better IR compared to groups treated with MTX or MTX combined with TNF blockers (group 1, 3 and 5). Patients treated with TNF-blockers as monotherapy (group 2 and 4) had numerically somewhat lower IR but not significantly different compared to controls for both serotypes.

Positive immune response (posIR) was defined as >= 2 times increase in antibody levels compared to baseline. Patients with RA exhibited reduced responsiveness compared to patients with SpA in univariate analysis. In multivariate analysis only older age and MTX treatment predicted reduced response while ongoing systemic prednisolone treatment elicited better posIR, table 1.

Conclusion:

Higher age and treatment with methotrexate predicted an impaired immune response to the 7-valent conjugate pneumococcal vaccine in this cohort of patients with chronic arthritis. Concomitant prednisolone treatment was associated with better IR. TNF-blockers did not affect the immune responses significantly.

Table 1. Predictors of positive immune response (pos IR) for both 23F and 6B.

    95% C.I. for EXP (B)
 BP-valueExp(B)LowerUpper
Age (years)-0.0240.0240.9770.9570.997
Gender (male/female)0.2480.3601.2820.7532.181
Disease duration (years)0.0150.2081.0150.9921.039
RA diagnosis (yes/no)-0.2830.3350.7530.4241.340
Swollen join count (SJC28)-0.0370.6180.9630.8321.115
Tender join count (TJC28)0.0010.9791.0010.9281.079
ESR (mm/h)0.0110.0981.0110.9981.025
HAQ (0–3)-0.3160.1790.7290.4601.155
Methotrexate (yes/no)-0.7260.0030.4840.2970.787
Anti-TNF (yes/no)0.0390.8821.0390.6251.729
Prednisolone (orally: yes/no)0.6890.0171.9911.1313.505
Pneumovax vaccination previously (yes/no)-0.2210.6300.8020.3271.969
Smoking (yes/no)-0.2680.3940.7650.4131.416

To cite this abstract, please use the following information:
Kapetanovic, Meliha C., Roseman, Carmen, Jonsson, Göran, Truedsson, Lennart, Saxne, Tore, Geborek, Pierre; Methotrexate but Not TNF-Blockers Reduces Immune Response Following Pneumococcal Vaccination Using 7-Valent Conjugate Pneumococcal Vaccine (Prevenar) in Adult Patients with Established Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1440
DOI: 10.1002/art.29206

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